This article may need to be cleaned up. It has been merged from Anti-anxiety medication.
|Synonyms||sedative, minor tranquilizer|
An anxiolytic (/ -/,; also antipanic or antianxiety agent) is a medication or other intervention that reduces anxiety. This effect is in contrast to anxiogenic agents which increase anxiety. Anxiolytic medications are used for the treatment of anxiety disorders and their related psychological and physical symptoms.
Nature of anxiety
Anxiety is a naturally-occurring emotion and an innate response of the body to the environmental stimuli. Mild to moderate anxiety would increase level of performance. However, when anxiety levels exceed the tolerability of a person, anxiety disorders may occur. People with anxiety disorders can exhibit fear responses such as defensive behaviors, high levels of alertness and negative emotions, without external stimuli which induce anxiety within an individual. Those with anxiety disorders are also often found to have concurrent psychological disorders, most commonly depression. Anxiety disorders are divided into 6 types in clinical recognition. They are as follows.
|Generalized anxiety disorders (GAD)||The anxiety symptoms are usually persistent and constant. Patients of this disorder could experience excessive anxiety for a long duration, commonly over 6 months and the symptoms could occur without any specific triggers.|
|Panic disorder||This disorder specifically refers to the suffering from panic attacks and also the fear of repetitive attacks. Commonly found in agoraphobia patients (the fear of difficulty in leaving a confined venue). Panic attacks are sudden upsurges in anxiety level usually with unexplained reasons.|
|Social phobia||This refers to the fear of staging in social situations where one experiences public observation among people or performs in front of the public. The fears are often unexplained and persistent. The fear could also be attributed to the possible humiliation in front of others due to poor performance or awkward social interactions.|
|Specific phobias||Persistent fear towards a specific object, either tangible or intangible. This leads to undeniable avoidance or thought of escape from the object or endurance of the object in immense levels of anxiety.|
|Posttraumatic stress disorder (PTSD)||PTSDs develop due to experience of severe trauma or life-threatening events. Specific symptoms include flashbacks of the traumatic events during the encounter to the similar situations and avoidance of these situations. The fear of re-experiencing the event are also associated with feelings of helplessness or horror.|
|Obsessive-compulsive disorder (OCD)||Person with OCD would experience compulsive impulses of removing an obsession. One common example in the obsession with impurities or contamination. The person would have compulsion or urge in sterilizing the environment to remove the contamination. Another example is the obsession with orderliness. The person would manipulate the surroundings including visual presentations to ease their compulsion.|
Different types of anxiety disorders will share some general symptoms while having their own distinctive symptoms. This explains why people with different types of anxiety disorders will respond differently to different classes of anti-anxiety medications.
The etiology of anxiety disorder remains unknown. There are several contributing factors that are still yet to be proved to cause anxiety disorders. These factors include childhood anxiety, drug induction by central stimulant drugs, metabolic diseases or having depressive disorder.
Anti-anxiety medication is any drug that can be taken or prescribed for the treatment of Anxiety disorders. Anxiety disorders can be mediated by neurotransmitters like norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA) in the central nervous system. Anti-anxiety medication can be classified into six types according to their different mechanisms: antidepressants, benzodiazepines; buspirone; antiepileptics; antipsychotics; and beta-adrenoceptor antagonists.
Antidepressants including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCA), Monoamine oxidase inhibitor (MAOI). SSRIs are used in all types of anxiety disorders while SNRIs are used for generalized anxiety disorder (GAD). Both of them are considered as first-line anti-anxiety medications. TCAs are second-line treatment as they cause more significant adverse effects when compared to the first-line treatment. Benzodiazepines are effective in emergent and short-term treatment of anxiety disorders due to their fast onset but carry the risk dependence. Buspirone is indicated for GAD, which has much slower onset but with the advantage of less sedating and withdrawal effects.
Anti-anxiety medications have been known to cause many adverse reactions as well as addiction and withdrawal symptoms.
The first monoamine oxidase inhibitor (MAOI), iproniazid, was discovered accidentally when developing the new antitubercular drug isoniazid. The drug was found to cause euphoria and improve the patient's appetite and sleep quality.
The first Tricyclic antidepressant, Imipramineis, was developed by modifying the structure of antihistamine (Promethazine). TCAs can increase the level of norepinephrine and serotonin by inhibiting their reuptake transport proteins. The majority of TCAs exert greater effect on norepinephrine, which leads to side effects like drowsiness and memory loss.
In order to be more effective on serotonin agonism and avoid anticholinergic and antihistaminergic side effects, selective serotonin reuptake inhibitors (SSRI) to treat anxiety disorder. First SSRI, fluoxetine, was reported in 1974 and approved by FDA in 1987. After that, few more SSRI like sertraline, paroxetine, escitalopram have entered the market.
The first serotonin norepinephrine reuptake inhibitor (SNRI), venlafaxine, entered the market in 1993. SNRIs can target serotonin and norepinephrine transporters while imposing insignificant effect on other adrenergic (α1, α2, and β), histamine (H1), muscarinic, dopamine, or postsynaptic serotonin receptors.
There are six groups of anti-anxiety medications available that have been proven to be clinically significant in treatment of anxiety disorders. The groups of medications are as follows.
|Antidepressants (e.g.SSRIs, SNRIs)||SSRIs e.g. fluoxetine, sertraline; SNRIs e.g. venlafaxine; MAOIs; TCAs|
|Benzodiazepines||Lorazepam, diazepam, alprazolam|
|Antiepileptics||Gabapentin, pregabalin, tiagabine and valproate|
Medications that are indicated for both anxiety disorders and depression. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are new generations of antidepressants. They have a much lower adverse effect profile than older antidepressants like monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressant (TCAs). Therefore, SSRIs and SNRIs are now the first-line agent in treating long term anxiety disorders, given their applications and significance in all 6 types of disorders.
Benzodiazepines are used for acute anxiety and could be added along with current use of SSRIs to stabilize a treatment. Long-term use in treatment plans is not recommended. Different kinds of benzodiazepine will vary in its pharmacological profile, including its strength of effect and time taken for metabolism. The choice of the benzodiazepine will depend on the corresponding profiles.
Benzodiazepines are used for emergent or short-term management. They are not recommended as the first-line anti-anxiety drugs, but they can be used in combination with SSRIs/SNRIs during the initial treatment stage. Indications include panic disorder, sleep disorders, seizures, acute behavioral disturbance, muscle spasm and premedication and sedation for procedures.
Useful in GAD but not effective in treating phobias or social anxiety disorders.
Useful in treating GAD
Olanzapine and risperidone are atypical antipsychotics which are also effective in GAD and PTSD treatment. However, there is also a higher chance of experiencing adverse effects than the other anti-anxiety medications.
Propranolol is originally used for heart diseases. It can also be used to treat anxiety with symptoms like tremor or increased heart rate. They work on the nervous system and alleviate the symptoms as a relief.
Mechanism of Action
Selective serotonin reuptake inhibitors (SSRI) and serotonin and norepinephrine reuptake inhibitors (SNRI)
Both SSRIs and SNRIs are reuptake inhibitors of a class of nerve signal transduction chemical called neurotransmitters. Serotonin and norepinephrine are neurotransmitters that are related to nervous control in mood regulation. The level of neurotransmitters are regulated by the nerve through reuptake to avoid accumulation of the neurotransmitter at the endings of nerve fiber. By reuptaking the produced neurotransmitter, the level will go back down and ready to go back up upon excitation from a new nerve signal. However the level of patients with anxiety disorders are usually low or their nerve fibers are insensitive to the neurotransmitters. SSRIs and SNRIs will then block the channel of reuptake and increase the level of the neurotransmitter. The nerve fibers will originally inhibit further production of neurotransmitters upon the increase. However the prolonged increase will eventually desensitize the nerve about the change in level. Therefore, the action of both SSRIs and SNRIs will take 4–6 weeks to exert their full effect.
Benzodiazepines bind selectively to the GABA receptor, which is the receptor protein found in the nervous system and is in control of the nervous response. Benzodiazepine will increase the entry of chloride ions into the cells by improving the binding between GABA and GABA receptors and then the better opening of the channel for chloride ion passage. The high level of chloride ion inside the nerve cells makes the nerve more difficult to depolarize and inhibit further nerve signal transduction. The excitability of the nerves then reduces and the nervous system slows down. Therefore, the drug can alleviate symptoms of anxiety disorder and make the person less nervous.
Selective serotonin reuptake inhibitors (SSRI)
Selective serotonin reuptake inhibitors (SSRIs) are a class of medications used in the treatment of depression, anxiety disorders, OCD and some personality disorders. SSRIs are the first-line anti-anxiety medications. Serotonin is one of the crucial neurotransmitters in mood enhancement, and increasing serotonin level produces an anti-anxiety effect. SSRIs increase the serotonin level in the brain by inhibiting serotonin uptake pumps on serotonergic systems, without interactions with other receptors and ion channels. SSRIs are beneficial in both acute response and long-term maintenance treatment for both depression and anxiety disorder.
SSRIs can increase anxiety initially due to negative feedback through the serotonergic autoreceptors, for this reason a concurrent benzodiazepine can be used until the anxiolytic effect of the SSRI occurs.
|Drug||Indication||Common side effect|
|-Acute angle closure glaucoma
(caused by decrease in dopamine release)
(active enantiomer of citalopram)
-Generalized anxiety disorder
-social anxiety disorder
The common early side effects of SSRIs include nausea and loose stool, which can be solved by discontinuing the treatment. Headache, dizziness, insomnia are the common early side effects as well.
Withdrawal symptoms like dizziness, headache and flu-like symptoms (fatigue/myalgia/loose stool) may occur if SSRI is stopped suddenly. The brain is incapable of upregulating the receptors to sufficient levels especially after discontinuation of the drugs with short half life like paroxetine. Both Fluoxetine and its active metabolite have a long half life therefore it causes the least withdrawal symptoms.
Serotonin–norepinephrine reuptake inhibitors (SNRI)
Serotonin–norepinephrine reuptake inhibitor (SNRIs) include venlafaxine and duloxetine drugs. Venlafaxine, in extended release form, and duloxetine, are indicated for the treatment of GAD. SNRIs are as effective as SSRIs in the treatment of anxiety disorders.
Tricyclic antidepressants (TCAs)
Tricyclic antidepressants (TCAs) have anxiolytic effects; however, side effects are often more troubling or severe and overdose is dangerous. They are considered effective, but have generally been replaced by antidepressants that cause different adverse effects. Examples include imipramine, doxepin, amitriptyline, nortriptyline and desipramine.
|Drugs||Indication||Common side effect|
|Imipramine||-Nocturnal enuresis for children above six years old
|-antihistamine side effects like sedation, weight gain
-anticholinergic side effect like blurred vision, dry mouth, constipation
-Phobic and obsessional states
TCAs may cause drug poisoning in patients with hypotension, cardiovascular diseases and arrhythmias.
Mirtazapine has demonstrated anxiolytic effect comparable to SSRIs while rarely causing or exacerbating anxiety. Mirtazapine's anxiety reduction tends to occur significantly faster than SSRIs.
Monoamine oxidase inhibitors
Monoamine oxidase inhibitors (MAOIs) are first-generation antidepressants effective for anxiety treatment but their dietary restrictions, adverse effect profile and availability of newer medications have limited their use. MAOIs include phenelzine, isocarboxazid and tranylcypromine. Pyrazidol is a reversible MAOI that lacks dietary restriction.
Barbiturates are powerful anxiolytics but the risk of abuse and addiction is high. Many experts consider these drugs obsolete for treating anxiety but valuable for the short-term treatment of severe insomnia, though only after benzodiazepines or non-benzodiazepines have failed.
Benzodiazepines are prescribed to quell panic attacks. Benzodiazepines are also prescribed in tandem with an antidepressant for the latent period of efficacy associated with many ADs for anxiety disorder. There is risk of benzodiazepine withdrawal and rebound syndrome if BZDs are rapidly discontinued. Tolerance and dependence may occur. The risk of abuse in this class of medication is smaller than in that of barbiturates. Cognitive and behavioral adverse effects are possible.
|Drug||Indication||Common Side effect|
|Lorazepam||-short term use in anxiety
-short term use in insomnia associated anxiety
-conscious sedation for procedures
-status epilepticus/febrile convulsions/convulsions caused by poisoning
-ataxia, confusion (more in elderly)
|diazepam||-muscle spasm of varied aetiology
-acute drug-induced dystonic reactions
-sedation for minor surgical and medical procedures
|alprazolam||-short term use in anxiety||-as all benzodiazepine[specify]|
Benzodiazepines lead to central nervous system depression, resulting in common adverse effects like drowsiness, oversedation, light-headedness. Memory impairment can be a common adverse effect especially in elderly, hypersalivation, ataxia, slurred speech, psychomotor effects.
Sympatholytics are a group of anti-hypertensives which inhibit activity of the sympathetic nervous system. Beta blockers reduce anxiety by decreasing heart rate and preventing shaking. Beta blockers include propranolol, oxprenolol, and metoprolol. The Alpha-1 agonist prazosin could be effective for PTSD. The Alpha-2 agonists clonidine and guanfacine have demonstrated both anxiolytic and anxiogenic effects.
Pregabalin (Lyrica) produces anxiolytic effect after one week of use comparable to lorazepam, alprazolam, and venlafaxine with more consistent psychic and somatic anxiety reduction. Unlike BZDs, it does not disrupt sleep architecture nor does it cause cognitive or psychomotor impairment.
Hydroxyzine (Atarax) is an antihistamine originally approved for clinical use by the FDA in 1956. Hydroxyzine has a calming effect which helps ameliorate anxiety. Hydroxyzine efficacy is comparable to benzodiazepines in the treatment of generalized anxiety disorder.
Phenibut (Anvifen, Fenibut, Noofen) is an anxiolytic used in Russia. Phenibut is a GABAB receptor agonist, as well as an antagonist at α2δ subunit-containing voltage-dependent calcium channels (VDCCs), similarly to gabapentinoids like gabapentin and pregabalin. The medication is not approved by the FDA for use in the United States, but is sold online as a supplement.
Mebicar is an anxiolytic produced in Latvia and used in Eastern Europe. Mebicar has an effect on the structure of limbic-reticular activity, particularly on the hypothalamus, as well as on all 4 basic neuromediator systems – γ aminobutyric acid (GABA), choline, serotonin and adrenergic activity. Mebicar decreases noradrenaline, increases serotonin, and exerts no effect on dopamine.
Fabomotizole (Afobazole) is an anxiolytic drug launched in Russia in the early 2000s. Its mechanism of action is poorly-defined, with GABAergic, NGF and BDNF release promoting, MT1 receptor agonism, MT3 receptor antagonism, and sigma agonism thought to have some involvement.
Bromantane is a stimulant drug with anxiolytic properties developed in Russia during the late 1980s. Bromantane acts mainly by facilitating the biosynthesis of dopamine, through indirect genomic upregulation of relevant enzymes (tyrosine hydroxylase (TH) and aromatic L-amino acid decarboxylase (AAAD)).
Etifoxine has similar anxiolytic effects as benzodiazepine drugs, but does not produce the same levels of sedation and ataxia. Further, etifoxine does not affect memory and vigilance, and does not induce rebound anxiety, drug dependence, or withdrawal symptoms.
Alternatives to medication
Cognitive behavioral therapy (CBT) is an effective treatment for panic disorder, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder, while exposure therapy is the recommended treatment for anxiety related phobias. Healthcare providers can guide those with anxiety disorder by referring them to self-help resources. Sometimes medication is combined with psychotherapy but research has not found a benefit of combined pharmacotherapy and psychotherapy versus monotherapy.
- "antianxiety agent" at Dorland's Medical Dictionary
- Whittlesea, Cate; Hodson, Karen, eds. (7 August 2018). Clinical pharmacy and therapeutics. ISBN 978-0-7020-7012-9. OCLC 1084882482.
- Kaur, Balwinder; Marwaha, Radhika; Chand, Subhash; Saini, Balraj (24 April 2021), "Nanoelectronics: Basic Concepts, Approaches, and Applications", Nanotechnology, Jenny Stanford Publishing, pp. 497–524, doi:10.1201/9781003120261-15, ISBN 978-1-003-12026-1, S2CID 234829940, retrieved 16 March 2022
- Hillhouse, Todd M.; Porter, Joseph H. (2015). "A brief history of the development of antidepressant drugs: From monoamines to glutamate". Experimental and Clinical Psychopharmacology. 23 (1): 1–21. doi:10.1037/a0038550. ISSN 1936-2293. PMC 4428540. PMID 25643025.
- "Rang and Dale's Pharmacology 7Th Edition Preface", Rang & Dale's Pharmacology, Elsevier, pp. xv, 2012, doi:10.1016/b978-0-7020-3471-8.00064-0, ISBN 9780702034718, retrieved 16 March 2022
- Kanba, S. (2004). "Although antidepressants and anxiolytics are frequently used together to treat depression in the acute phase, how effective is the concomitant use of these drugs?". Journal of Psychiatry & Neuroscience. 29 (6): 485. PMC 524966. PMID 15644990.
- Barlow, David H.; Durand, Mark V (2009). "Chapter 7: Mood Disorders and Suicide". Abnormal Psychology: An Integrative Approach (Fifth ed.). Belmont, CA: Wadsworth Cengage Learning. p. 239. ISBN 978-0-495-09556-9. OCLC 192055408.[page needed]
- Lochmann, Dee; Richardson, Tara (2018), Macaluso, Matthew; Preskorn, Sheldon H. (eds.), "Selective Serotonin Reuptake Inhibitors", Antidepressants, Cham: Springer International Publishing, vol. 250, pp. 135–144, doi:10.1007/164_2018_172, ISBN 978-3-030-10948-6, PMID 30838457, retrieved 16 March 2022
- Formulary., Committee, Joint (2014). British National Formulary. Pharmaceutical Press. ISBN 978-0-85711-152-4. OCLC 874322467.
- Stahl, Stephen M. (2011). Stahl's essential psychopharmacology : the prescriber's guide. Meghan M. Grady (4th ed.). Cambridge, UK: Cambridge University Press. ISBN 978-0-521-17364-3. OCLC 701672553.
- Bandelow, Borwin; Michaelis, Sophie; Wedekind, Dirk (June 2017). "Treatment of anxiety disorders". Generalized Anxiety Disorders. 19 (2): 93–107. doi:10.31887/dcns.2017.19.2/bbandelow. ISSN 2608-3477. PMC 5573566. PMID 28867934.
- John Vanin; James Helsley (19 June 2008). Anxiety Disorders: A Pocket Guide For Primary Care. Springer Science & Business Media. p. 189.
- Post, Jason W.; Migne, Louis J. (2012). Antidepressants : Pharmacology, Health Effects and Controversy. New York: Nova Science Publishers. p. 58. ISBN 9781620815557.
- "Tricyclic antidepressants (TCAs)". Mayo Clinic.
- Jemmali, Mahdi; Fayez, Fayez Al (28 April 2021). "Pre-compiling Parallel Algorithms for Compilers into a Network". dx.doi.org. doi:10.21203/rs.3.rs-405814/v1. S2CID 235509355. Retrieved 16 March 2022.
- Tanghe, A.; Geerts, S.; Van Dorpe, J.; Brichard, B.; Bruhwyler, J.; Géczy, J. (August 1997). "Double-blind randomized controlled study of the efficacy and tolerability of two reversible monoamine oxidase A inhibitors, pirlindole and moclobemide, in the treatment of depression". Acta Psychiatrica Scandinavica. 96 (2): 134–141. doi:10.1111/j.1600-0447.1997.tb09918.x. ISSN 0001-690X. PMID 9272198. S2CID 23485112.
- Burchum, Jacqueline Rosenjack; Rosenthal, Laura D. (29 January 2015). Lehne's pharmacology for nursing care (9th ed.). St. Louis, Missouri. ISBN 9780323321907. OCLC 890310283.
- Cassano, Giovanni B.; Rossi, Nicolò Baldini; Pini, Stefano (2002). "Psychopharmacology of anxiety disorders". Dialogues in Clinical Neuroscience. 4 (3): 271–285. doi:10.31887/DCNS.2002.4.3/gcassano. ISSN 1294-8322. PMC 3181684. PMID 22033867.
- Gelder, M, Mayou, R. and Geddes, J. 2005. Psychiatry. 3rd ed. New York: Oxford. pp236.
- Lader M, Tylee A, Donoghue J (2009). "Withdrawing benzodiazepines in primary care". CNS Drugs. 23 (1): 19–34. doi:10.2165/0023210-200923010-00002. PMID 19062773. S2CID 113206.
- Hayes, Peggy E.; Schulz, S. Charles (1987). "Beta-blockers in anxiety disorders". Journal of Affective Disorders. 13 (2): 119–30. doi:10.1016/0165-0327(87)90017-6. PMID 2890677.
- Jefferson, James W. (1974). "Beta-Adrenergic Receptor Blocking Drugs in Psychiatry". Archives of General Psychiatry. 31 (5): 681–91. doi:10.1001/archpsyc.1974.01760170071012. PMID 4155284.
- Koola, M. M.; Varghese, S. P.; Fawcett, J. A. (2013). "High-dose prazosin for the treatment of post-traumatic stress disorder". Therapeutic Advances in Psychopharmacology. 4 (1): 43–7. doi:10.1177/2045125313500982. PMC 3896131. PMID 24490030.
- Hoehn-Saric, Rudolf; Merchant, A. F.; Keyser, M. L.; Smith, V. K. (1981). "Effects of Clonidine on Anxiety Disorders". Archives of General Psychiatry. 38 (11): 1278–82. doi:10.1001/archpsyc.1981.01780360094011. PMID 7305609.
- Annual Reports in Medicinal Chemistry, Volume 32 p. 319
- DeMartinis, N.; Rynn, M.; Rickels, K.; Mandos, L. (February 2000). "Prior benzodiazepine use and buspirone response in the treatment of generalized anxiety disorder". The Journal of Clinical Psychiatry. 61 (2): 91–94. doi:10.4088/jcp.v61n0203. ISSN 0160-6689. PMID 10732655.
- Bandelow, Borwin; Wedekind, Dirk; Leon, Teresa (2014). "Pregabalin for the treatment of generalized anxiety disorder: A novel pharmacologic intervention". Expert Review of Neurotherapeutics. 7 (7): 769–81. doi:10.1586/14737220.127.116.119. PMID 17610384. S2CID 6229344.
- Owen, R.T. (2007). "Pregabalin: Its efficacy, safety and tolerability profile in generalized anxiety". Drugs of Today. 43 (9): 601–10. doi:10.1358/dot.2007.43.9.1133188. PMID 17940637.
- Llorca, Pierre-Michel; Spadone, Christian; Sol, Olivier; Danniau, Anne; Bougerol, Thierry; Corruble, Emmanuelle; Faruch, Michel; Macher, Jean-Paul; Sermet, Eric; Servant, Dominique (2002). "Efficacy and Safety of Hydroxyzine in the Treatment of Generalized Anxiety Disorder". The Journal of Clinical Psychiatry. 63 (11): 1020–7. doi:10.4088/JCP.v63n1112. PMID 12444816.
- Lapin, Izyaslav (2001). "Phenibut (β-Phenyl-GABA): A Tranquilizer and Nootropic Drug". CNS Drug Reviews. 7 (4): 471–481. doi:10.1111/j.1527-3458.2001.tb00211.x. ISSN 1527-3458. PMC 6494145. PMID 11830761.
- журнал», Издание для практикующих врачей «Русский медицинский. "Феномен аминофенилмасляной кислоты". www.rmj.ru. Retrieved 19 December 2018.
- Zvejniece, Liga; Vavers, Edijs; Svalbe, Baiba; Veinberg, Grigory; Rizhanova, Kristina; Liepins, Vilnis; Kalvinsh, Ivars; Dambrova, Maija (1 October 2015). "R-phenibut binds to the α2–δ subunit of voltage-dependent calcium channels and exerts gabapentin-like anti-nociceptive effects". Pharmacology Biochemistry and Behavior. 137: 23–29. doi:10.1016/j.pbb.2015.07.014. ISSN 0091-3057. PMID 26234470. S2CID 42606053.
- Owen, David R.; Wood, David M.; Archer, John R. H.; Dargan, Paul I. (2016). "Phenibut (4-amino-3-phenyl-butyric acid): Availability, prevalence of use, desired effects and acute toxicity". Drug and Alcohol Review. 35 (5): 591–596. doi:10.1111/dar.12356. hdl:10044/1/30073. ISSN 1465-3362. PMID 26693960.
- Cohen, Pieter A.; Ellison, Ross R.; Travis, John C.; Gaufberg, Slava V.; Gerona, Roy (22 September 2021). "Quantity of phenibut in dietary supplements before and after FDA warnings". Clinical Toxicology. 60 (4): 486–488. doi:10.1080/15563650.2021.1973020. PMID 34550038. S2CID 237594860.
- "Adaptol. Summary of Product Characteristics" (PDF). Archived from the original (PDF) on 3 December 2015. Retrieved 24 July 2015.
- Val'dman AV, Zaikonnikova IV, Kozlovskaia MM, Zimakova IE (1980). "[Characteristics of the psychotropic spectrum of action of mebicar]". Biulleten' Eksperimental'noĭ Biologii I Meditsiny (in Russian). 89 (5): 568–70. PMID 6104993.
- Neznamov, GG; Siuniakov, SA; Chumakov, DV; Bochkarev, VK; Seredenin, SB (2001). "Clinical study of the selective anxiolytic agent afobazol". Eksperimental'naia i Klinicheskaia Farmakologiia. 64 (2): 15–9. PMID 11548440.
- Silkina, IV; Gan'shina, TC; Seredin, SB; Mirzoian, RS (2005). "Gabaergic mechanism of cerebrovascular and neuroprotective effects of afobazole and picamilon". Eksperimental'naia i Klinicheskaia Farmakologiia. 68 (1): 20–4. PMID 15786959.
- Vakhitova IuV, Iamidanov RS, Seredinin SB (2004). "[Ladasten induces the expression of genes regulating dopamine biosynthesis in various structures of rat brain]". Eksp Klin Farmakol (in Russian). 67 (4): 7–11. PMID 15500036.
- Vakhitova, Yu. V.; Yamidanov, R. S.; Vakhitov, V. A.; Seredenin, S. B. (2005). "The effect of ladasten on gene expression in the rat brain". Doklady Biochemistry and Biophysics. 401 (1–6): 150–153. doi:10.1007/s10628-005-0057-z. ISSN 1607-6729. PMID 15999825. S2CID 28048257.
- Volchegorskii, I. A.; Miroshnichenko, I. Yu.; Rassokhina, L. M.; Faizullin, R. M.; Malkin, M. P.; Pryakhina, K. E.; Kalugina, A. V. (2015). "Comparative Analysis of the Anxiolytic Effects of 3-Hydroxypyridine and Succinic Acid Derivatives". Bulletin of Experimental Biology and Medicine. 158 (6): 756–61. doi:10.1007/s10517-015-2855-3. PMID 25894772. S2CID 6052275.
- Rumyantseva, S. A.; Fedin, A. I.; Sokhova, O. N. (2012). "Antioxidant Treatment of Ischemic Brain Lesions". Neuroscience and Behavioral Physiology. 42 (8): 842–5. doi:10.1007/s11055-012-9646-3. S2CID 39971165. INIST:26388033.
- "Validol". The Great Soviet Encyclopedia.
- "Farmak Product Information - Validol" (PDF). Archived from the original (PDF) on 19 December 2013. Retrieved 9 April 2013.
- Malykh, Andrei G.; Sadaie, M. Reza (2010). "Piracetam and Piracetam-Like Drugs". Drugs. 70 (3): 287–312. doi:10.2165/11319230-000000000-00000. PMID 20166767. S2CID 12176745.
- Nuss, Philippe; Ferreri, Florian; Bourin, Michel (2019). "An update on the anxiolytic and neuroprotective properties of etifoxine: from brain GABA modulation to a whole-body mode of action (Review)". Neuropsychiatric Disease and Treatment. 15: 1781–1795. doi:10.2147/ndt.s200568. ISSN 1178-2021. PMC 6615018. PMID 31308671.
- Gilman, J. M.; Ramchandani, V. A.; Davis, M. B.; Bjork, J. M.; Hommer, D. W. (2008). "Why We Like to Drink: A Functional Magnetic Resonance Imaging Study of the Rewarding and Anxiolytic Effects of Alcohol". Journal of Neuroscience. 28 (18): 4583–91. doi:10.1523/JNEUROSCI.0086-08.2008. PMC 2730732. PMID 18448634.
- Shearer, Steven L. (2007). "Recent Advances in the Understanding and Treatment of Anxiety Disorders". Primary Care: Clinics in Office Practice. 34 (3): 475–504, v–vi. doi:10.1016/j.pop.2007.05.002. PMID 17868756.
- Pull, Charles B (2007). "Combined pharmacotherapy and cognitive-behavioural therapy for anxiety disorders". Current Opinion in Psychiatry. 20 (1): 30–5. doi:10.1097/YCO.0b013e3280115e52. PMID 17143079. S2CID 43737803.
- CMA & AMA Home medical guides 2012 & 2014[full citation needed]
- Media related to Anxiolytics at Wikimedia Commons